(August late post)
So August is here. Most of us had have our end of year evaluations and managed to pass out with flying colours. I did gloriously too with a little help of ‘Covid derogations’ application. Which basically means, some of the tick boxes I did not achieve this year did not not hold me back from progressing to next year because it was assumed that part of the training was affected by the pandemic. Example getting a certain number of clinics for the given year. Since a majority portion of our outpatient appointments are still functioning as only essential slots to avoid face to face contacts which would mean less learning opportunities for us.
Some have managed to find hospital accommodations to live in by now, some of the junior docs are still probably looking for mates to share a flat or the house. Hopefully still not living B&B to B&B or couch surfing at friend’s dragging a massive plastic bag of clothes living a hobo life. Lets see; a PJ, a blanket, a towel and 2-3 days of work uniforms? Sounds about right. Lets lump it all aside in one corner, everything in place just a few fumble away in a plastic bag. When you finish a row of night shifts at one hospital on the 2nd of August and are expected to work the same day for the next placement in an entirely new setup in a different hospital on the 2nd; you will be doing that too. But, worry not my friends. Soon you’ll have days when you will be sitting on a fancy restaurant on a fancy outfit having a fancy meal on your hard earned pay check.
ARCP as in ‘the end of year evaluation’ of trainees usually happens on last weeks of June or first few weeks of July. Nothing really to worry about if one is keeping in track with their portfolio and ticking checks left and right on number of cases, procedures, feedbacks and so on. But can be quite a struggle if you are not determined enough to sit down and work on it between or after shifts or have a dedicated few hours at least once a week just allocated to it. In a way for doctors in training in UK, we breathe our life in and out around our ‘portfolios.’ It is evidence to show career progression and without proof on it to back the competency levels, no one will pass the year.
‘Portfolio’ is quite a work. From my experience, more when you are new to the hospital environment; especially when you are new to the training system. It really helps if you are an extrovert and have great people skills but that does not mean introverts won’t get anything done. It will take you a little longer time to catch up on pace but you’ll get there. This year alone, we needed 12 people to sign us off in a category called ‘Multisource feedback MSF’ which is sort of like a character statement where our colleagues would be asked to comment on us on our communication skills, attitude, team player role, reliability/punctuality and leadership. These feedbacks will be from combination of people from different job roles apart from the doctors like nurses, pharmacist, health care assistants, physiotherapists, patient flow coordinators etc. We needed 4 multi consultant (MCRs) report on our performances, 4 ACATs (acute care assessment tool) where we present 5 cases each to our on-call consultants for our evaluations and additionally, 4 CBD(case based discussion) or minicexs-where we again discuss history, examination and management of each individual cases we saw in depth. On a rough estimate, by the end of year, those were at least 9-10 consultants we were following around in and out of our rotations to get our sign offs. The number maybe even more, if you are unable to get the same consultant to sign you off on multiple forms.
Undoubtedly it is going to be a tough year if you are under a sore eye of even one consultant, especially in a small DGH (District General Hospital). Trainees talk, trainers too. You’d be surprised how much of chitchats and dramas flows from floor to floor between meals, between clinics and between ward rounds. A whisper about a medical student here and it has reached a consultant’s ear on the other building top floor by the day’s end. Be careful of what you say and especially as a foreign trainee with thick accent ‘be careful of how you say it’. Control your pitch. Do some humming exercise if you have to. Control your flow of your speech, aim to articulate as distinctly as possible. Count seconds between words if you have to. And if its the pronunciation that comes out as naturally harsh expression not because you mean it but that is how you speak in your natural mother tongue language; for example if the words you are speaking is a throat sound which may not be as softer tone as from chest vocalisation almost a whisper like British people are used to… follow it with a big smile. Trust me watching that smile, adds a whole different meaning to the sentence you just spoke than listening over phone or without your facial expression on equation. There are other cultural aspects too to approaching a conversation that you will eventually learn as a foreign grad. For example it took me quite a bit time, to set the loudness of my voice to adjust to a conversation. Naturally I have a soft voice. In my culture, you always address your seniors with lower or softer voice. Being loud is considered a sign of disrespect. Now that in UK’s setting, may be perceived as lack of confidence. Children here are encouraged to speak up from a young age, there is levelling of hierarchy to encourage good learning environment. Confidence is about expressing thoughts, being heard and getting a feedback in some form suggesting given view was acknowledged. In setting I was raised and taught on, its unidirectional flow, almost always. I remember, during my initial days in the job in UK, I was being constantly asked to be louder when I was presenting or handing over. I often felt a little frustrated. It felt as though it was disrespect to me because I am being asked again and again to repeat myself. But looking retrospectively, I can see where the problem is. And as I tried to adapt, I started going the other end, practicing to be louder which I didn’t realise with my accent was posing another problem. I was starting to sound rude to people when all I was trying honest to god was to just dial my tone to right decibels. ‘Smile.’ Trust me, it works great as non verbal communication method to support gaps where you might be lacking. Although, I do have to let you know my high school teacher once said to us, ‘as girls/women one has to be very careful of how openly one smile at others. It might send a wrong message’.
It does makes a big difference to have a right environment setup where trainees are supported well with their requirements without hustling day and night for a sign off and where the trainers/ consultants are approachable & encouraged to help trainees meet their competencies as part of an educational process.
Some seniors readily agree. Mostly the ones, who themselves have just come out of the system and are well aware how tedious it is to get these little checks. Some will out out rightly reject you and want you to prove yourself more before they can make a comment, which is fair. Only problem is, in ever changing and busy world of NHS, consultants are barely on same shift on 2 days in a row. The case you saw last with them they may not be able to recall next time (probably after 2-3 weeks) in which instance they may ask you to repeat the same process again. Also need to be aware, if they were only visiting/locum consultants you may miss an opportunity for sign off as visiting consultants are not responsible for your training.
I cannot stress enough how important ‘People skills’ are in our profession whether with patients, with colleagues or with seniors. Especially in a profession like surgery where everything you are trying to be is almost a copy of complete persona of your supervising surgeon- the posture, the movements of hands, the precision of scalp incision, the steps of procedurals technique, the suturing skills etc etc and, everything you will grasp is a perfected skillset handed down after years and years of practice. And although it is not 17th century unlike when The Chameberlen family hid their discovery of forceps for 5 generations within themselves and devoid the world of marvels of their important discovery; having just an average level of rapport skills will prove to be unfair disadvantage. Remember world of Medicine is still a learning environment. You are a teacher and you are a student.
One has to make sure, they get a good educational supervisor allocated for the given year. Luckily for me, I found out on time that I could request the deanery to reallocate me the same supervisor I had last year. A supervisor’s job role is a big responsibility in a sense that the allocated consultant will be the mentor/the guardian for the given trainee’s entire year. He/She will have a big role guiding the trainee through their career development keeping a close eye on their portfolio while advising and supporting them on both personal and professional levels. My supervisor has gone out and beyond to help me this year and I am really grateful.
I have handed my job responsibilities, signed off my outcome sheet for this year and now, am sitting on a chair on a bright afternoon day at 1:30pm on a weekday having morning tea. The black week has come and gone and the consultants seem to be feeling more settled in trusting the new doctors with their job roles.
As most of were leaving current hospital placement to other, we delivered some cards to our seniors thanking for their support. ‘It is hard to see you guys leave every year.’ Our consultant said. ‘You only start remembering the names by midyear and by the end of year most of you would move away. You get attached. Then you have to do the same thing again with new trainees. Year by year’.
Anyways, for me ‘August is done’. No more portfolios, no more on-calls and night shift for few months. No more exams, courses and seminars. I have been picking agency shifts to pay my rent and stay afloat as and when I can and that is all. The freedom of picking your own time to work? Nothing beats the feeling! I am really glad that HEE have now taken more steps to provide opportunities to trainees to take career breaks and get into part training programs. A couple of my colleagues have also recently applied to go 80%, 60%. Training is UK is really long compared to anywhere else in the world. Going part time will add extra years. But I suppose most of are at that phase in life where we all feel, as long as their is some progression it is alright.
As I may have explained before, one no longer needs to fill those extensive forms to prove one falls in the certain quota to be accepted for the breaks or part time programs. It’s a great start. Both for trainees and NHS. In past years trainees have been leaving NHS left and right to work in private sectors or to work outside in different countries. Australia used to be most popular destination. Now my colleagues are leaving for New Zealand, USA, some of them are even going to middle east. A couple of them are thinking of changing career paths. So, yeah, for both of us, it is a good start.
As for me, with all this time in my hand now, I need to crack on slowly with my little list of things to do in life. Sort out the clutters slowly, clear my diaries to make room for more plans. Finally, finally I feel like I am ready to embrace my 30s. 20s went so fast. Its like that 2 years of COVID most of us were not ready to accept that we had lost it in one click of a finger. Time equates to memories, I think. When you look back and can’t remember much of what you did those years, you don’t seem to be able to track it. I suppose, I now understand what they mean when they say ‘its not about how long you live, its about you live it.’